About Us

• Collaborates with the UM RN to determine the appropriate hospital setting (inpatient vs. observation) based on medical necessity.

• Performs concurrent and retrospective utilization management-related activities and functions to ensure that appropriate data are tracked, evaluated, and reported including Important Message from Medicare (IMM) and Medicare Outpatient Observation Notice (MOON) completion.

• Communicates clinical information with payors via phone, fax, and computer system per payer contract to obtain authorization for appropriate level of care and length of stay as needed.

• Obtains authorization for admission / concurrent stay for designated units.

• Provides prompt feedback regarding payor determinations to UM RN.

• Attends meetings and prepares agendas and minutes.

• Handles incoming and outgoing office correspondence; answers and directs department phone calls as needed.

• Performs general office duties including faxing, copying, scanning and filing. Orders department supplies.

• Communicates with internal and external customers to answer questions.

• Troubleshoots problems that arise with office equipment. Notifies leadership of unresolved issues.

• Performs other related duties as required and directed.

Qualifications:

Required

• Associate degree in healthcare-related field
• Two years of clerical experience
• One-year experience in a heath care environment utilizing medical terminology or have completed a college level course in medical terminology

Preferred:

• Bachelor’s degree in coding/medical records/billing or healthcare related field
• Two years of case management or utilization review, billing, or coding experience
• Three years of recent experience doing third party payer certification
• Basic Life Support (BLS) certification as a Healthcare Provider by the American Heart Association, American Red Cross or equivalent through the Military Training network (MTN)

Knowledge, Skills, and Abilities:

• Ability to handle multiple tasks and complete work within short timeframes.
• Ability to understand, interpret, explain, and use data for case management activities.
• Ability to work with diverse teams and individuals, team player.
• Able to spend majority of time utilizing a computer, monitor, keyboard and mouse; ability to type.
• Competency in applying the principles, methods, materials, and equipment necessary in
  providing utilization management services.
• Demonstrated expertise in utilization management principles, methods, and tools and incorporating them into the daily operations of the organization.

• Excellent time management and organization skills.

• Knowledge of care delivery systems across the continuum of care including, but not limited to, trends and issues in care reimbursement, medical necessity and assigning level of care assignment (inpt vs obs).
• Must be able to act calmly and effectively in busy/stressful environment.
• Must be able to work independently, and utilize problem solving techniques and critical thinking skills.

• Proficient with Microsoft Office (i.e., Word, Excel, Outlook, and Power Point).
• Strong verbal and written communication skills: ability to interact productively with leaders, peers, and customers.
• Must be able to travel to subsidiaries or corporate meetings as needed.

• Weekend, holiday, and evening coverage as per site requirements.